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General NPI Number Information
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NPI Number | 1982709770
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Entity Type | Organization
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Legal Business Name | BOYS & GIRLS CLUB OF BISBEE,AZ,INC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 405 ARIZONA ST
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City | BISBEE
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State | AZ
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Zip | 85603-1503
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Country | US
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Telephone | 520-432-3010
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Fax | 520-432-6903
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Provider Business Mailing Address
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Address Line | 405 ARIZONA ST
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City | BISBEE
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State | AZ
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Zip | 85603
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Country | US
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Telephone | 520-432-3010
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Fax | 520-432-6903
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ANNETTE RENTERIA
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Credential |
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Telephone | 520-432-3010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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